The Utilization Management Supervisor, Senior Care Options is a key member of our Dual-eligible Special Needs Plan (DSNP) Senior Care Options product medical management team. The Supervisor is responsible for the daily supervision and operations of the SCO Utilization Management team as the team carries out the requirements of the SCO Model of Care and the contractual requirements of CMS and MassHealth.

The Supervisor may carry a caseload based on business needs. This caseload will include the management of prior authorization of services, where required, and concurrent review of inpatient stays. The Supervisor collaborates regularly with the Director of Utilization Management, Plan Medical Directors, SCO Care Management staff and other SCO team members, members’ PCPs, requesting providers, and facility care management staff.

Certified Coding Professional (CPC) or other medical coding certification

Experience:

1 year of prior supervisory experience

5 years Registered Nurse experience, including 2 years direct care services and 3 years of any combination of utilization management, discharge planning in an acute care setting, or health plan clinical operations experience at a staff level

Ability to interact within all levels of the organization as well as with external parties

Strong working knowledge of Microsoft Office products.

Demonstrated organization and time management skills

Strong analytical and clinical problem solving

Ability to prioritize work

Detail oriented

Internal Number: 2013647

About Boston Medical Center HealthNet Plan

Imagine working for an organization committed to making a difference. Founded in 1997 by Boston Medical Center (BMC), BMC HealthNet Plan supports the mission of BMC by providing medical care access to the underserved, disabled, elderly and other vulnerable populations.
BMC HealthNet Plan is a not-for-profit, market leading managed care organization that offers health insurance coverage to low-to-moderate income individuals in Massachusetts and New Hampshire (where it is known as Well Sense Health Plan). We offer health insurance plans in the Medicaid and commercial markets, and contract with health care providers and hospitals throughout Massachusetts and New Hampshire.
We employ over 600 individuals in Charlestown, Massachusetts and Manchester, New Hampshire. We offer our employees highly competitive benefits, compensation package and flexible work arrangement options. To demonstrate our commitment to serving the community, our employees are entitled to eight hours of paid volunteer time per year.
BMC HealthNet Plan employees are a diverse, talented workforce that work together to represent our values – member focus, stewardship, partnership, quality, inclusion and integrity.